Dec 31 Nelson, women and the health insurance bill

I am not a woman. I wouldn't dare speak for women. But my life and activism are intricately tangled with that of women and that of women's rights. I worked hard - phone-banking night after night - in 2006 - to defeat Proposition 73, the first of three consecutive parental notification measures on the California ballot in as many years since. We defeated 73. We defeated every one of them since. But the bastards keep coming back. I took away my dad's pen when he was filling out his mail-in ballot last year and was about to vote for Prop 4, last year's parental notification measure on the California ballot. I took away his pen and had a half-hour conversation with him until I convinced him to vote 'No.'

But I'm getting off topic. This post is about the House and the Senate health care bills. Let me be clear: I don't like either the Stupak language or the Nelson language. Among the two, I prefer Nelson as the lesser of the two evils. It requires insurance companies to separate their accounting for abortion coverage and fund it only with private dollars. States can opt out of even this. Not good. But better than Stupak. The Stupak language would ban insurance plans being sold on the exchanges from offering abortion coverage, period. As I pointed out before, contrary to the demands of some, it is not possible for a House-Senate conference committee to drop both. But I don't want to make this an abortion-coverage diary. While the right to an abortion is critical to women's rights overall, it should not be overshadowing all the other important health issues women face, and how the bills score on those. I want to talk about what both the House and the Senate bills do to actually improve women's health care.Require maternity, well-baby and well-child care: Insurers will be required to cover basic maternity care as an essential service under their policies. Today, 79% of the women who buy coverage in the individual market do not have maternity care included in their coverage. Not only will all insurance companies participating in the exchanges be required to provide this coverage, but in time, so would insurance companies that are not part of the exchange. In addition, children will be covered for medical as well as dental, vision and hearing for up to 21 years of age.

Outlawing gender rating: Under both bills, insurance companies are expressly prohibited from discriminating in their premiums based on gender. Currently, insurance companies charge women up to 48% more than men for health insurance. In fact, premiums are not allowed to vary in either bill except on the basis of three factors: age, tobacco use, and family size. Sen. Barbara Boxer of California, a unabashed champion of women's issues as well as reproductive rights, spoke on about the problem under the status quo:

Senator Barbara Boxer, Democrat of California, in her floor speech on Thursday said: “Only 14 states in America require insurance companies to cover maternity care. Imagine, in a country that puts family values first, only 14 states. That will change. And everyone is faced with huge increased costs, but women 18 to 55 are charged nearly 40 percent more than men for similar coverage in my home state.”

That will no longer happen under the current bills heading to conference.

Ending pre-existing conditions: This doesn't sound very women specific, but it has added benefits for women, because discrimination based on pre-existing conditions hurt women more. In addition to all the pre-existing conditions men can have, insurance companies have thus far also considered domestic violence, c-sections and pregnancy itself as "pre-existing" condition.

The insurance exchange: Even though women are 50% of the American paid work force today, they are far less likely to enjoy health insurance benefits at their workplace. One reason for that is that 25% of the female work force work part-time and thus are generally ineligible for full-time benefits. In comparison, only 11% of the male work force is employed part time. Another reason is that women tend to work in smaller companies and places likely to both pay less and provide less, if any, benefits. As a result, employed women are 12% less likely to have coverage through their employer than men. An insurance exchange that levels the playing field in the individual insurance market and use the purchasing power of its members as a group would help close the coverage gap for women both in quantity and quality.

Expanded coverage: Expanded coverage with mandated maternity care would mean better reproductive health. Better information about what to do and not to do during a pregnancy. Care if complications result from pregnancy. Aren't these reproductive rights issues? Isn't it possible that if more people had coverage and maternity care, that we would have less miscarriages, less preventable suffering of women during pregnancy and a lower infant mortality rate? Aren't those reproductive rights issues?

So I ask you to think again if you think the bills should be killed simply because of the Nelson language, which seems likely to be in the final bill. I ask you to consider whether women's rights and women's access to and affordability of abortion would improve in any manner if we fail to enact a health care bill. It would not. But women would be left without the advantages mentioned above. Do not forget that the Nelson rule applies to the exchanges only. Who would use the exchanges? For the most part, people who cannot otherwise obtain insurance (through their employer). Today, they have no coverage. None. Not for abortions. And not for breast cancer screening. Not for maternity care. Not well baby care. Nothing.